PROLIA J Code: J0897

Drug & Product Overview

HCPCS Descriptor Injection, denosumab, 1 mg

HCPCS Added Date January 1, 2012

Manufacturer Amgen

Route of Administration Subcutaneous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection

About PROLIA

Prolia is a medication aligned to the HCPCS J Code: J0897 for billing, pricing, and reimbursement purposes in the United States. This Osteoporosis medication is administered via the subcutaneous route and manufactured by Amgen.

According to CMS Drug Use Information: Denosumab is used to treat bone loss (osteoporosis) in people who have a high risk of getting fractures. Osteoporosis causes bones to become thinner and break more easily. Your chance of developing osteoporosis increases after menopause (in women), as you age, if someone in your family has osteoporosis, or if you take certain medications (such as prednisone) for long periods. This medication works by slowing bone loss to help maintain strong bones and reduce the risk of broken bones (fractures). Denosumab belongs to a class of drugs called monoclonal antibodies. It prevents certain cells in the body (osteoclasts) from breaking down bone. This monograph is about the following denosumab products: denosumab, denosumab-bbdz, denosumab-bmwo, denosumab-bnht, denosumab-desu, denosumab-dssb, denosumab-kyqq, denosumab-nxxp, and denosumab-qbde.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
55513-0710-01	Prolia	Amgen, Inc	60	60 MG / 1 ML
55513-0710-21	Prolia	Amgen, Inc	60	60 MG / 1 ML
55513-0730-01	Xgeva	Amgen, Inc	120	120 MG / 1.7 ML
55513-0730-21	Xgeva	Amgen, Inc	120	120 MG / 1.7 ML

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PROLIA Pricing & Reimbursement

J0897 Private Payer Reimbursement

$30.18 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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Historical Graphing and Billing Calculator

per HCPCS unit

As of Q4 2026

Denosumab Biosimilar Information:

PROLIA Approval Date: June 1, 2010

Product Name	HCPCS Code	Active Ingredient	BLA Type
Prolia	J0897	Denosumab	351(a) Originator Product
Jubbonti and Wyost	Q5136	Denosumab	351(k) Interchangeable
Ospomyv and Xbryk	Q5159	Denosumab	351(k) Interchangeable
Stoboclo and Osenvelt	Q5157	Denosumab	351(k) Interchangeable
Bomyntra and Conexxence	Q5158	Denosumab	351(k) Interchangeable
Bildyos and Bilprevda	Q5162	Denosumab	351(k) Interchangeable
Aukelso and Bosaya	Q5161	Denosumab	351(k) Interchangeable
Enoby and Xtrenbo	Q5167	Denosumab	351(k) Interchangeable
Osvyrti and Jubereq	Q5166	Denosumab	351(k) Interchangeable
Oziltus	Q5165	Denosumab	351(k) Interchangeable
Boncresa	Q5171	Denosumab	351(k) Interchangeable
Ponlimsi	Q5173	Denosumab	351(k) Interchangeable

PROLIA Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 19.09%

Avg. Days to File 12.2days

Avg. Days to Pay 26.8days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J0897 claims analytics on FocalPoint →

PROLIA CPT Administration Codes

CPT Code	Description
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular

JW / JZ modifiers apply

CMS has identified Prolia (J0897) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

PROLIA Medically Unlikely Edits (MUE)

The most billing units of J0897 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient

120 units / day

= 120 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

PROLIA Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer Bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer Giant Cell Tumor of Bone Glucocorticoid-induced osteoporosis Hypercalcemia of Malignancy Multiple Myeloma and Bone Metastasis from Solid Tumors Osteoporosis in men Postmenopausal osteoporosis at high risk for fracture

Drug Class

RANK Ligand Blocking Activity [MoA]RANK Ligand Inhibitor [EPC]

Frequently Asked Questions

Is there an available Prolia billing and coding guide?

Billing and coding information for PROLIA can be found through Amgen. Visit Here →

Are there any available Prolia patient assistance programs?

PROLIA patient assistance information can be found through Amgen. Visit Here →

Where can I find Prolia prescribing information?

PROLIA prescribing information can be found at the link below: Visit Here →

Where can I find Prolia side effect information?

Information regarding PROLIA's side effects can be found at MedlinePlus Visit Here →

Does billing PROLIA require JZ/JW wastage modifiers?

CMS has identified PROLIA(J0897) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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